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Ferreira NR, Marto CM, de Sousa BM, Loureiro M, Oliveira AT, DosSantos MF, Rodrigues MJ. Synthesis of temporomandibular disorders management intervention outcomes for development of core outcome sets: A systematic review. J Oral Rehabil 2024; 51:1303-1319. [PMID: 38572886 DOI: 10.1111/joor.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/12/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The selection of appropriate outcomes in clinical trials and systematic reviews is a crucial factor in determining the results that are useful, reliable, and relevant for both patients and healthcare professionals. Clinicians and researchers have been encouraged to develop and apply core outcome sets (COS) to minimise the discrepancy between studies. AIM This systematic review is the first phase of the COS development project for clinical trials in temporomandibular disorders (COS-TMD). It aims to identify and synthesise the outcomes used in the randomised controlled trials (RCT) that evaluated the effectiveness of interventions used in TMD management. MATERIALS AND METHODS An electronic search was performed in several databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library and EMBASE. The eligibility criteria comprised RCT that applied any intervention to treat temporomandibular joint disorders or masticatory muscle disorders. The identified outcomes were categorised according to domains of the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT). RESULTS The electronic search resulted in 1606 studies. After removing duplicates and applying the eligibility criteria, 106 RCT were included. A total of 43 studies evaluated masticatory muscle disorders, 27 evaluated temporomandibular joint disorders, and 36 analysed mixed TMD. CONCLUSIONS The evaluation showed significant variability in the types of outcomes and their measurement instruments. In addition, some domains such as physical and emotional functioning, participant ratings of global improvement and adverse events have been neglected when determining the effectiveness of treatments for TMD.
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Affiliation(s)
- N R Ferreira
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - C M Marto
- Faculty of Medicine, Institute of Experimental Pathology, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra, CACC, Coimbra, Portugal
| | - B M de Sousa
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - M Loureiro
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - A T Oliveira
- Postgraduate Program in Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - M F DosSantos
- Postgraduate Program in Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Laboratory of Mechanical Properties and Cell Biology (PropBio) School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - M J Rodrigues
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
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Saini RS, Ali Abdullah Almoyad M, Binduhayyim RIH, Quadri SA, Gurumurthy V, Bavabeedu SS, Kuruniyan MS, Naseef PP, Mosaddad SA, Heboyan A. The effectiveness of botulinum toxin for temporomandibular disorders: A systematic review and meta-analysis. PLoS One 2024; 19:e0300157. [PMID: 38483856 PMCID: PMC10939295 DOI: 10.1371/journal.pone.0300157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE The current body of research on utilizing botulinum toxin (BTX) to manage temporomandibular disorders (TMDs) has not yet yielded definitive conclusions. The primary objective of this study was to determine the effectiveness of BTX in pain reduction for TMDs compared to placebo and other treatments. The secondary outcomes evaluated were adverse events, maximum mouth opening, bruxism events, and maximum occlusal force. MATERIALS AND METHODS A literature search was performed on PubMed, Dimension Publication, Scopus, and Google Scholar. The RoB 2 tool was used for quality assessment. The mean differences in pain scores were estimated to measure the effect of BTX on pain reduction. For adverse events, the risk ratio for the incidence of side effects was calculated. RESULTS Two hundred and sixty non-duplicate articles were identified; however, only 14 RCTS were included in this review. The total study population included 395 patients. The overall risk of bias showed a low to moderate quality of evidence. Results from 6 studies were reported only narratively; four studies were used for meta-analysis on pain reduction, and five were used for meta-analysis on adverse events. The control used in the meta-analysis was placebo injections. Results of the meta-analysis for pain reduction were statistically insignificant for the BTX group with mean differences at MD = -1.71 (95% CI, -2.87 to -0.5) at one month, -1.53 (95% CI, -2.80 to -0.27) at three months, and -1.33 (95% CI, -2.74 to 0.77) at six months. This showed that BTX treatment was not significantly better than placebo for a reduction in pain scores at 1, 3, and 6 months. Regarding safety, the placebo group showed a relative risk of 1.34 (95%CI, 0.48-6.78) and 1.17 (95%CI, 0.54-3.88) at 1 and 3 months respectively. However, the risks were not statistically significant. There was also no difference in the effectiveness of BTX compared to placebo and other treatments for maximum mouth opening, bruxism events, and maximum occlusal force. CONCLUSION BTX was not associated with better outcomes in terms of pain reduction, adverse events, maximum mouth opening, bruxism events, and maximum occlusal force. More high-quality RCTs are needed to better understand this topic.
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Affiliation(s)
- Ravinder S. Saini
- Department of Dental Technology, COAMS, King Khalid University, Abha, Saudi Arabia
| | | | | | | | | | - Shashit Shetty Bavabeedu
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | | | | | - Seyed Ali Mosaddad
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Sàbado-Bundó H, Sánchez-Garcés M, Camps-Font O, Gay-Escoda C. Intraarticular injections of hyaluronic acid in arthrocentesis and arthroscopy as a treatment of temporomandibular joint disorders: A systematic review. Cranio 2024; 42:122-131. [PMID: 34027829 DOI: 10.1080/08869634.2021.1925029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the benefits of hyaluronic acid intraarticular injection (HA IAI), in conjunction with minimally invasive surgery (arthrocentesis or arthroscopy), as a therapeutic option for temporomandibular joint disorders. METHODS An electronic search in PubMed, Cochrane Library, and Scopus databases was conducted in order to answer the following PICOS question: "In clinical trials with patients treated with arthroscopy or arthrocentesis, did the subsequent use of HA IAI provide a better control of postoperative pain and temporomandibular joint function compared to those patients who did not receive it?" RESULTS Following PRISMA criteria, six randomized controlled clinical trials were selected. HA IAI showed significant differences in terms of pain reduction in three of them and improvement of mandibular function in two, compared to the control group. CONCLUSION Based on scientific evidence, the level of recommendation found regarding this type of intervention is type B (recommendation based on inconsistent or limited-quality patient-oriented evidence).
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Affiliation(s)
- Helena Sàbado-Bundó
- Department of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - MaÁngeles Sánchez-Garcés
- Master's Degree Program in Oral Surgery and Implantology, University of Barcelona, Barcelona, Spain
- Researcher of the IDIBELL Institute, Barcelona, Spain
| | - Octavi Camps-Font
- Department of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Researcher of the IDIBELL Institute, Barcelona, Spain
| | - Cosme Gay-Escoda
- Oral and Maxillofacial Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Oral Surgery and Implantology, FUCSO, Implantology and Maxillofacial Surgery Department, EFHRE International University, Teknon Medical Center, Barcelona, Spain
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Agostini F, Ferrillo M, Bernetti A, Finamore N, Mangone M, Giudice A, Paoloni M, de Sire A. Hyaluronic acid injections for pain relief and functional improvement in patients with temporomandibular disorders: An umbrella review of systematic reviews. J Oral Rehabil 2023; 50:1518-1534. [PMID: 37608244 DOI: 10.1111/joor.13571] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Temporomandibular disorders (TMD) are the main cause of chronic facial pain, and intra-articular (IA) injections of hyaluronic acid (HA) are commonly performed. OBJECTIVES This umbrella review of systematic reviews aimed at analysing the effectiveness of HA injections on pain and functional outcomes in patients affected by TMD. METHODS PubMed, Cochrane Library and PEDro were systematically searched from inception until 17 January 2023 to identify systematic reviews evaluating the effects on pain and functional outcomes of HA IA injections. PROSPERO registration number: CRD42022382586. RESULTS Out of 316 papers suitable for title/abstract screening, 18 articles were included in the umbrella review. Thirteen studies included only randomized controlled clinical trials (RCTs). The included systematic reviews reported no statistically significant differences between HA and corticosteroids, whereas platelet derivates seem to have good results in pain relief. The literature did not show severe adverse events, except for mild pain in the site of injection. Concerning the quality assessment of the 18 systematic reviews, 2 (11.11%) had a high quality, 3 (16.67%) a moderate quality, 7 (38.89%) a low quality and 6 (33.33%) a critically low quality. CONCLUSIONS Taken together, findings of this umbrella review showed intriguing effects of IA HA injections in terms of reduction of pain intensity and improvement of functioning in patients affected by TMD. Furthermore, there is no agreement on the effectiveness of a combination of arthrocentesis or arthroscopy with IA HA injections. Although the literature showed these positive results after IA HA injections, the overlapping of primary studies in the systematic reviews included might have affect our results, such as the very low quality of the papers. Thus, further RCTs are needed to confirm the efficacy of IA injections of HA on pain relief in patients with TMD.
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Affiliation(s)
- Francesco Agostini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele, Rome, Italy
| | - Martina Ferrillo
- Dentistry Unit, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Andrea Bernetti
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, Lecce, Italy
| | - Nikolaos Finamore
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Amerigo Giudice
- Dentistry Unit, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Marco Paoloni
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Raveggi E, Ramieri G, Bosco GF, Zavattero E. Temporomandibular joint arthrocentesis: a single-center experience and review of the literature. Minerva Dent Oral Sci 2023; 72:69-76. [PMID: 37052194 DOI: 10.23736/s2724-6329.22.04653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND The aim of this paper was to report our experience and to review the literature of arthrocentesis focusing on protocols and results. METHODS Arthrocentesis with supplemental hyaluronic acid was performed in patients with TMDs between January 2017 and December 2020 at the Division of Maxillofacial Surgery. The maximum interincisal opening (MIO) and pain score were recorded preoperatively (T0), 2 months postoperatively (T1), and 6 months postoperatively (T2). A literature search was performed to analyze the same parameters in patients with TMDs. Patient demographic, characteristics and treatment protocols used were also recorded. RESULTS This retrospective analysis enrolled 45 patients. Twenty-two patients (20 females, 2 males) with mean age of 37.13 years with internal derangement were included in study group A. Study group B included 23 patients with degenerative joint disease (19 females and 4 males) with mean age of 55.73 years. The outcomes trend of MIO and pain during the follow-up period showed a gradual improvement. Fifty articles meeting the proposed scientific criteria were selected for the literature revision. A range of clinical and procedural variables were analyzed by grouping the studies into two broad categories based on the diagnosis of TMD. CONCLUSIONS Based on our experience and on the basis of the most accredited scientific studies in the literature, intra-articular injections of HA are beneficial for the improvement of the pain and/or functional symptoms of TMDs.
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Affiliation(s)
- Elisa Raveggi
- Division of Maxillofacial Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guglielmo Ramieri
- Division of Maxillofacial Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giovanni F Bosco
- Division of Maxillofacial Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Emanuele Zavattero
- Division of Maxillofacial Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy -
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Hyder A, Tawfik BE, Elmohandes W. Efficacy of computer-guided versus conventional sodium hyaluronate injection in superior joint space in treatment of temporomandibular joint (TMJ) internal derangement: Comparative randomized controlled trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e321-e326. [PMID: 35545190 DOI: 10.1016/j.jormas.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES evaluate the feasibility and clinical outcomes of computer-guided sodium hyaluronate injection in superior joint space compared to conventional injection for the treatment of TMJ Internal Derangement (TMJ-ID). PATIENTS AND METHODS Randomized controlled trial conducted on 40 patients diagnosed with bilateral TMJ-ID divided into two groups. Group A treated with four computer-guided sodium hyaluronate injections in superior TMJ space with one-week intervals. Group B received similar injections but with the conventional method. The intraoperative assessment included total procedural time and patient convenience during the injection. The postoperative evaluation included maximum unassisted mouth opening (MUMO), modified Helkimo's clinical dysfunction index, and pain intensity on a visual analog scale (VAS). RESULTS Group A showed better improvement in maximum mouth opening and pain intensity than group B after a week of the second, third and fourth injection. At the six months, group A continued to show better improvement regarding maximum mouth opening, while improvement in pain and TMJ dysfunction was similar in both groups. There were differences between both groups regarding procedural time and patient convenience across the study except the time of the first injection, which was similar in both groups CONCLUSION: Using the virtual planning and injection guide for intra-articular TMJ injection is considered promising to increase the accuracy and efficacy of injectable material securing faster results besides rendering the procedure easily reproducible and simpler to both clinicians and patients. However, the authors could not ensure the long-term superiority of the computer-guided injection technique over the conventional one in light of the results of this study.
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Affiliation(s)
- AbdElKader Hyder
- Assistant Lecturer of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Azhar University, 11884, ElNasr Road, Nasr City, Cairo, Egypt.
| | - Bahaa Eldin Tawfik
- Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
| | - Wael Elmohandes
- Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
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Chęciński M, Chęcińska K, Nowak Z, Sikora M, Chlubek D. Treatment of Mandibular Hypomobility by Injections into the Temporomandibular Joints: A Systematic Review of the Substances Used. J Clin Med 2022; 11:2305. [PMID: 35566431 PMCID: PMC9102811 DOI: 10.3390/jcm11092305] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular abduction. The purpose of this review is to identify other injectable substances and to evaluate them in the above-mentioned domains. MATERIAL AND METHODS The review included articles describing clinical trials of patients treated with intra-articular injections with or without arthrocentesis. RESULTS The following emerging substances were initially evaluated to be effective in treating TMJ pain and increasing the amplitude of mandibular abduction: analgesics, dextrose with lidocaine, adipose tissue, nucleated bone marrow cells and ozone gas. DISCUSSION Better effects of intra-articular administration are achieved by preceding the injection with arthrocentesis. CONCLUSIONS The most promising substances appear to be bone marrow and adipose tissue.
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Affiliation(s)
- Maciej Chęciński
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland;
| | - Kamila Chęcińska
- Department of Glass Technology and Amorphous Coatings, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, Mickiewicza 30, 30-059 Cracow, Poland;
| | - Zuzanna Nowak
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta 2, 41-800 Zabrze, Poland;
| | - Maciej Sikora
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland;
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
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Ritto FG, Cueto AP, Dos Santos Canellas JV, Zuniga JR, Tiwana PS, Pimentel T, Medeiros PJ. Arthrocentesis versus nonsurgical methods in the management of temporomandibular joint closed lock and pain: a double-blind randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:369-376. [PMID: 34373214 DOI: 10.1016/j.oooo.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The present double-blind randomized clinical trial aimed to compare the efficacy of conservative treatment and articular lavage, either alone or combined, to reduce joint pain and improve mandibular opening. STUDY DESIGN The sample consisted of patients presenting with limited mouth opening and joint pain. The diagnosis was made according to the diagnostic criteria for temporomandibular disorders guideline and confirmed by magnetic resonance imaging. Sixty patients were selected and randomly allocated to 4 groups of 15 patients each with different treatments: group A (conservative), group B (conservative + medication), group C (arthrocentesis), and group D (arthrocentesis + medication). The groups were compared in terms of maximal interincisal opening and pain. RESULTS The average age of the patients was 34.17 ± 13.1 years, 88.1% were women, 72.9% had internal derangement, 54% had joint sounds, and 55.9% presented with locking. Clinical improvement was noted in all parameters compared with baseline in all groups (P < .005), but no significant differences were observed when the groups were compared (P > .05). CONCLUSIONS Both arthrocentesis and conservative modalities were efficient treatments to reduce joint pain and increase mandibular opening.
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Affiliation(s)
- Fabio G Ritto
- Department of Oral and Maxillofacial Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil.
| | - Alexander Pomares Cueto
- Department of Oral and Maxillofacial Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - John R Zuniga
- Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Paul S Tiwana
- Department of Oral and Maxillofacial Surgery, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Thais Pimentel
- Department of Oral and Maxillofacial Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Jose Medeiros
- Department of Oral and Maxillofacial Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Liapaki A, Thamm JR, Ha S, Monteiro JLGC, McCain JP, Troulis MJ, Guastaldi FPS. Is there a difference in treatment effect of different intra-articular drugs for temporomandibular joint osteoarthritis? A systematic review of randomized controlled trials. Int J Oral Maxillofac Surg 2021; 50:1233-1243. [PMID: 33642154 DOI: 10.1016/j.ijom.2021.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
A systematic review based on the PRISMA guidelines was conducted to investigate and compare treatment with hyaluronic acid (HA), corticosteroids, and blood products in patients with temporomandibular joint osteoarthritis (TMJOA). The MEDLINE/PubMed, Embase, and Cochrane Library databases were searched for articles published until September 25, 2019. Articles met the inclusion criteria if they reported patients with TMJOA, a comparison group, and a follow-up period of at least 6 months. The mean and standard deviation for TMJ pain and maximum mouth opening (MMO) were reported. Nine studies involving 443 patients were included. Injectables and Ringer's lactate solution or normal saline were reported to significantly improve TMJ pain and MMO. Regarding TMJ pain, two studies showed a significant superiority of plasma rich in growth factors (PRGF)/platelet-rich plasma (PRP) injections with or without arthrocentesis over HA, but HA showed a significant improvement compared to corticosteroids. For MMO, no injectable was found to be superior to Ringer's lactate or a normal saline control, but arthrocentesis + PRP resulted in MMO improvement compared to arthrocentesis + HA. Overall, all injectables in conjunction with arthrocentesis were efficient in alleviating pain and improving MMO in TMJOA patients; however, a meta-analysis was not possible due to heterogeneity across studies.
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Affiliation(s)
- A Liapaki
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - J R Thamm
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - S Ha
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - J L G C Monteiro
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - J P McCain
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - M J Troulis
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - F P S Guastaldi
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
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Iturriaga V, Vásquez B, Bornhardt T, Del Sol M. Effects of low and high molecular weight hyaluronic acid on the osteoarthritic temporomandibular joint in rabbit. Clin Oral Investig 2021; 25:4507-4518. [PMID: 33392807 DOI: 10.1007/s00784-020-03763-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the effect between intra-articular infiltration of low molecular weight (LMW-HA) and high molecular weight hyaluronic acid (HMW-HA) on the histopathological characteristics of the cartilage and disc of the temporomandibular joint (TMJ) osteoarthritis (OA) induced in rabbits. MATERIAL AND METHODS An experimental study was conducted on 38 rabbit TMJs. The effect of different hyaluronic acids was compared at 30 and 135 days. Histopathological analysis was performed. Cartilage damage was assessed with the OARSI scale. RESULTS The severity of the induced OA according to OARSI was 3.4 degrees in the mandibular condyle (MC) and 3.2 in the mandibular fossa (MF); the articular disc (AD) presented disorganization of the collagen fibers, with randomly arranged hypertrophic chondrocytes. At 30 days, untreated TMJs worsened. TMJ treated with LMW-HA reduced its severity to 1.5 degrees in MC and 1.6 in MF, the AD presented histological aspects within normal limits. TMJ treated with HMW-HA presented 2.4 degrees in MC and 2.2 in MF, the AD maintained characteristics similar to the group with OA. At 135 days, all groups worsened. CONCLUSION Exogenous HA is effective in the management of TMJ-OA induced in rabbits, showing cartilage and articular disc repair at 30 days. The LMW-HA group had better effects on joint tissue than HMW-HA 30 days after treatment. However, at 135 days, both groups presented regression of joint tissue repair. CLINICAL RELEVANCE HA is effective in the anti-arthritic treatment of TMJ-OA induced in rabbits; LMW-HA shows better results in cartilage and articular disc repair than HMW-HA.
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Affiliation(s)
- Veronica Iturriaga
- Department of Integral Adult Care Dentistry, Temporomandibular Disorder and Orofacial Pain Program, Sleep & Pain Research Group, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Bélgica Vásquez
- Faculty of Health Sciences, Universidad de Tarapacá, Avenida 18 de Septiembre #2222, Arica, Chile.
| | - Thomas Bornhardt
- Department of Integral Adult Care Dentistry, Temporomandibular Disorder and Orofacial Pain Program, Sleep & Pain Research Group, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Mariano Del Sol
- Center of Excellence in Morphological and Surgical Studies (CEMyQ), Doctoral Program in Morphological Sciences, Universidad de La Frontera, Temuco, Chile
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Comparison of the Efficiacy of Intra-Articular Injection of Liquid Platelet-Rich Fibrin and Hyaluronic Acid After in Conjunction With Arthrocentesis for the Treatment of Internal Temporomandibular Joint Derangements. J Craniofac Surg 2020; 31:1870-1874. [PMID: 32433129 DOI: 10.1097/scs.0000000000006545] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the effectiveness of intra-articular injection of liquid platelet-rich fibrin (I-PRF) versus hyaluronic acid (HA) following arthrocentesis in patients suffering from temporomandibular joint (TMJ) pain and dysfunction. A total of 69 patients with internal TMJ derangement were enrolled in this retrospective, matched cohort study. A total of 47 included patients (67 joints) were divided into 3 groups as follows: 16 participants in the arthrocentesis-only group; 14 patients in the arthrocentesis plus HA injection group (A+HA); and 17 participants in the arthrocentesis plus I-PRF injection group (A+I-PRF). The 2 outcome variables were TMJ pain and maximal mouth opening (MMO) which were evaluated up to 12 months postoperatively. The data were analyzed using the Shapiro-Wilk test, Kruskal-Wallis test, Mann-Whitney U test, Wilcoxon sign test, Fisher exact test, and the χ test. Statistically significant decreases in pain scores and increases in MMO values were observed in all 3 groups during the 12 months of follow-up. The significant decrease in pain values was shown in the A+I-PRF group as compared with the A+HA group at 9 months postoperatively. MMO values in the A+I-PRF group were significantly higher than in the A+HA group at 9 and 12 months postoperatively. All conventional treatment procedures can provide pain reduction and improvement to MMO. However, intraarticular injections of I-PRF in combination with arthrocentesis showed superior performance in terms of the gradual improvement in pain alleviation and range of mouth opening.
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Derwich M, Mitus-Kenig M, Pawlowska E. Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis-Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E225. [PMID: 32397412 PMCID: PMC7279162 DOI: 10.3390/medicina56050225] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023]
Abstract
Background and objectives: There are an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth.
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Affiliation(s)
- Marcin Derwich
- Department of Orthodontics, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Maria Mitus-Kenig
- Department of Prophylaxis and Experimental Dentistry, Jagiellonian University in Krakow, 31-007 Krakow, Poland;
| | - Elzbieta Pawlowska
- Department of Orthodontics, Medical University of Lodz, 90-419 Lodz, Poland;
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Monteiro JLGC, de Arruda JAA, Silva EDDOE, Vasconcelos BCDE. Is Single-Puncture TMJ Arthrocentesis Superior to the Double-Puncture Technique for the Improvement of Outcomes in Patients With TMDs? J Oral Maxillofac Surg 2020; 78:1319.e1-1319.e15. [PMID: 32343959 DOI: 10.1016/j.joms.2020.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/19/2020] [Accepted: 03/15/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Arthrocentesis is a common treatment for temporomandibular joint disorders. Although modifications of the standard double-puncture technique have been described, no consensus has been reached regarding which is the best. The aim of the present study was to compare the outcomes of the single- and double-puncture arthrocentesis techniques (SPT and DPT, respectively). MATERIALS AND METHODS A systematic review following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines was performed. Two independent reviewers conducted electronic searches in the MEDLINE/PubMed, Cochrane Library, and Scopus databases for relevant studies reported up to January 2019. Studies comparing type I SPT (only 1 cannula) or type II SPT (2 soldered cannulas) to conventional DPT were considered. Data regarding the maximal mouth opening (MMO), joint pain, and operative time were extracted for the meta-analysis. In the case of statistically significant heterogeneity (P < .10), a random effects model was used to assess the significance of the treatment effects. Otherwise, a fixed effects model was used. The included randomized controlled trials (RCTs) were assessed for methodologic quality using the Cochrane Collaboration tool. RESULTS Nine studies were included for qualitative synthesis. Two were suitable for quantitative synthesis per outcome. The meta-analysis did not find any differences between SPT and DPT in relation to the MMO. However, in relation to joint pain, the results slightly favored the use of DPT. No differences in operative time were found between type I SPT and DPT (P = .49). CONCLUSIONS The present study found no differences between the SPT and DPT in relation to the MMO, and no difference was found in operative time between the DPT and type I SPT. Because of the heterogeneity between studies, it might be interesting to conduct more homogeneous RCTs to elucidate which technique results in better clinical outcomes.
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Affiliation(s)
- João Luiz Gomes Carneiro Monteiro
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, Brazil.
| | - José Alcides Almeida de Arruda
- Postgraduate Student, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Emanuel Dias de Oliveira E Silva
- Adjunct Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, Brazil
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Arthrocentesis and Sodium Hyaluronate Infiltration in Temporomandibular Disorders Treatment. Clinical and MRI Evaluation. J Funct Morphol Kinesiol 2020; 5:jfmk5010018. [PMID: 33467234 PMCID: PMC7739436 DOI: 10.3390/jfmk5010018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 11/25/2022] Open
Abstract
Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment efficacy. The aim of this study was to evaluate the clinical indexes variation in patients affected by temporomandibular joint disorders treated with arthrocentesis and sodium hyaluronate (SH) injections. A total of 28 patients suffering from temporomandibular joint disorders underwent one cycle of five arthrocentesis and infiltrations of sodium hyaluronate. Spontaneous mouth opening improved from 36.3 ± 7.5 mm to 45.1 ± 1.9 mm at six months follow-up. A significant reduction in the pain at rest and during mastication mean values emerged at follow-up (p < 0.0001). The mean masticatory efficiency, evaluated through a visual analogic scale, showed improvement at the follow-up period, highlighted by the increase of mean value from a baseline of 3.1 ± 1.2 to a mean value of 8.5 ± 1.2 (p < 0.0001). The mean severity of the joint damage at baseline time was 2.4 ± 0.9 and decreased to 0.4 ± 0.3 at the end of the follow-up period. The decrease in values is confirmed by statistical test (p < 0.05). Our data show how arthrocentesis integrated with sodium hyaluronate infiltrations performed under local anesthesia is a valid method of treating temporomandibular joint disorders.
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Liu Y, Wu JS, Tang YL, Tang YJ, Fei W, Liang XH. Multiple Treatment Meta-Analysis of Intra-Articular Injection for Temporomandibular Osteoarthritis. J Oral Maxillofac Surg 2020; 78:373.e1-373.e18. [DOI: 10.1016/j.joms.2019.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/17/2019] [Accepted: 10/16/2019] [Indexed: 01/15/2023]
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Prospective study to evaluate the influence of joint washing and the use of hyaluronic acid on 111 arthrocentesis. Oral Maxillofac Surg 2019; 23:415-421. [PMID: 31264124 DOI: 10.1007/s10006-019-00789-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Temporomandibular dysfunction is a generic term that covers a large number of clinical problems affecting not only temporomandibular joint but also the masticatory musculature and related structures. Arthrocentesis is used in patients with joint pathology in which conservative treatment has failed. METHODS A prospective, observational, analytical cohort study has been carried out to evaluate the results of 111 arthrocentesis. We have performed an inferential statistics study between the variables: improvement of pain and improvement in the oral opening with the variables and access joint, washing joint, hyaluronic acid infiltration, and type of joint pathology. RESULTS Joint washing and intra-articular hyaluronic acid injection significantly improved the pain at 1-week, 1-month, and 3-month postarthrocentesis, although this improvement was limited in time, at 6 months, joint washing and hyaluronic acid infiltration are no longer significant. Only the joint access (p = 0.014) and the type of joint pathology (p = 0.028) are significant. CONCLUSIONS The effectiveness of joint access in the arthrocentesis at 6 months is high, although less than at 1-month and 3-month postarthrocentesis. The type of joint pathology is another important factor. Patients with degenerative pathology worsen the most after 6-month postarthrocentesis. Arthrocentesis could avoid the evolution of acute pathology.
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Is Repeated Arthrocentesis Beneficial in the Treatment of Temporomandibular Disorders: A Retrospective Study. J Oral Maxillofac Surg 2019; 77:1359-1364. [PMID: 30825439 DOI: 10.1016/j.joms.2019.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/20/2019] [Accepted: 01/24/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE Arthrocentesis is an effective, simple, and minimally invasive treatment in patients with temporomandibular joint (TMJ) closed lock (CL). The aim of this study was to compare the effectiveness of 1- versus 2-session arthrocentesis procedures in the management of TMJ CL. MATERIALS AND METHODS A retrospective cohort study was conducted using the files of patients with TMJ CL according to diagnostic criteria for temporomandibular disorders. Patients who underwent 1- or 2-session arthrocentesis were included in the study. The decision of whether to undergo 1- or 2-session arthrocentesis was made by the patients: Those who accepted a second arthrocentesis procedure were assigned to group 1 (repeated arthrocentesis group), and those who did not accept, to group 2 (arthrocentesis group). The primary predictor variable was treatment method. TMJ pain (scored on a visual analog scale) and maximum mouth opening (MMO) were selected as the outcome variables. To evaluate the clinical outcomes of 1- or 2-session arthrocentesis, MMO and pain score (on a visual analog scale) before treatment and at 1, 3, and 6 months' follow-up were analyzed. Descriptive, comparative, correlation, and multivariate analyses were conducted. RESULTS A total of 30 patients (25 female and 5 male patients) with TMJ disc displacement without reduction were enrolled in the study. Each group consisted of 15 patients. Statistically significant decreases in pain scores and increases in MMO values were observed in both treatment groups at 3 and 6 months (P < .05). At 6 months, MMO values were significantly higher and pain levels were significantly lower in patients who received 2 arthrocentesis procedures. CONCLUSIONS Repeated arthrocentesis is more successful at reducing pain and improving MMO than a single intervention in the treatment of TMJ CL.
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Bergstrand S, Ingstad HK, Møystad A, Bjørnland T. Long-term effectiveness of arthrocentesis with and without hyaluronic acid injection for treatment of temporomandibular joint osteoarthritis. J Oral Sci 2019; 61:82-88. [PMID: 30814387 DOI: 10.2334/josnusd.17-0423] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This study evaluated the long-term effectiveness of intra-articular temporomandibular joint arthrocentesis for patients with osteoarthritis and compared arthrocentesis/lavage alone with arthrocentesis/lavage and injected hyaluronic acid. Forty patients met the inclusion criteria, and 37 completed long-term follow-up (approximately 4 years). The patients were randomly allocated to two groups: arthrocentesis with lavage alone (A-group, n = 17) or combined with hyaluronic acid treatment (AS-group, n = 20). Standard two-needle arthrocentesis was performed. Pain and joint sounds were measured at baseline and approximately 4 years after treatment. Reported pain, as indicated by visual analogue scale (VAS) score, significantly decreased from baseline to the final follow-up examination in both groups. Mean VAS score decreased from 64 to 16 (P < 0.001) in the A-group and from 63 to 25 (P < 0.001) in the AS-group. Average maximum incisor opening increased significantly in both groups but did not significantly differ between groups (P = 0.223). Joint sounds did not significantly improve within groups (A-group, P = 0.495; AS-group, P = 0.236). Both methods resulted in significant long-term improvements in pain and jaw function.
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Affiliation(s)
- Sara Bergstrand
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
| | - Hanne K Ingstad
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
| | - Anne Møystad
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
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Yilmaz O, Candirli C, Balaban E, Demirkol M. Evaluation of success criteria for temporomandibular joint arthrocentesis. J Korean Assoc Oral Maxillofac Surg 2019; 45:15-20. [PMID: 30847292 PMCID: PMC6400701 DOI: 10.5125/jkaoms.2019.45.1.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/18/2018] [Accepted: 05/06/2018] [Indexed: 11/07/2022] Open
Abstract
Objectives The aim of this study was to use four sets of success criteria to evaluate the outcomes of arthrocentesis treatment with hyaluronic acid injection in patients with internal derangement (ID) of the temporomandibular joint (TMJ). Materials and Methods The study included 40 patients diagnosed with unilateral Wilkes stage III TMJ dysfunction. Clinical parameters, including maximum mouth opening (MMO) and pain during function, were evaluated preoperatively, 6 months, and 1 year after TMJ arthrocentesis. Outcomes were assessed and compared using four sets of success criteria from the following: the American Association of Oral and Maxillofacial Surgeons (AAOMS; MMO ≥35 mm and visual analogue scale [VAS] score ≤3), Murakami et al.'s criteria (MMO >38 mm and VAS score <2), Emshoff and Rudisch criteria (MMO ≥35 mm and >50% pain reduction), and patient self-reports (self-evaluation of treatment as successful or unsuccessful). Results Significant improvements in MMO and pain reduction during function were observed between the preoperative period and 6 months and 1 year postoperatively (P<0.01). The success rates of treatment determined using AAOMS (52.5%), Emshoff and Rudisch criteria (57.5%), and self-reported patient criteria (40.0%) were similar. Application of the Murakami et al. criteria reported the lowest success rate (12.5%). Conclusion The AAOMS and Emshoff and Rudisch criteria are consistent with patient expectations and can be used to assess treatment efficacy.
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Affiliation(s)
- Onur Yilmaz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | - Celal Candirli
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | - Emre Balaban
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | - Mehmet Demirkol
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
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Pasqual PGV, Poluha RL, Setogutti ÊT, Grossmann E. Evaluation of effusion and articular disc positioning after two different arthrocentesis techniques in patients with temporomandibular joint disc displacement without reduction. Cranio 2018; 38:256-263. [PMID: 30165804 DOI: 10.1080/08869634.2018.1511266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate joint effusion and positioning of the articular disc through magnetic resonance imaging (MRI) before and after two different arthrocentesis techniques. METHODS Twenty-six patients with dislocation of the articular disc without reduction (ADDwoR) were included and randomly divided into two groups: single needle arthrocentesis with distention of the upper compartment of the TMJ (A1) and conventional arthrocentesis with 2 needles (A2). RESULTS A statistically significant difference was observed between the different effusion categories (p = 0.009). No differences were found comparing both treatment modalities concerning the position of the mandibular condyle and the articular disc. CONCLUSION Conventional arthrocentesis was able to change the effusion variable, whereas the single needle arthrocentesis was not. Both techniques were responsible for altering the position of the mandibular head or the disc-head complex, projecting them to a more anterior position related to the increase in the final maximum interincisal distance.
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Affiliation(s)
| | | | | | - Eduardo Grossmann
- Department of Dentistry, Craniofacial Pain Applied to Dentistry, Dentistry Faculty, Federal University of Rio Grande do Sul , Porto Alegre, RS, Brazil
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Ferreira N, Masterson D, Lopes de Lima R, de Souza Moura B, Oliveira AT, Kelly da Silva Fidalgo T, Carvalho ACP, DosSantos MF, Grossmann E. Efficacy of viscosupplementation with hyaluronic acid in temporomandibular disorders: A systematic review. J Craniomaxillofac Surg 2018; 46:1943-1952. [PMID: 30249483 DOI: 10.1016/j.jcms.2018.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To perform a systematic review of the viscosupplementation effectiveness with hyaluronic acid (HA) in the articular Temporomandibular Dysfunctions (TMDs) clinical management. METHOD Electronic searches were performed in the following databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library, EMBASE, LILACS, BBO, SIGLE (System for Information on Grey Literature in Europe), ClinicalTrials.gov, and the Brazilian Clinical Trials Registry (ReBec). Only randomized clinical trials that evaluated the intra-articular administration of HA or its derivatives in osteoarthritis and/or anterior displacement of the temporomandibular joint (TMJ) disc were included. The primary outcomes evaluated were patients' self-report of pain and/or discomfort in the TMJ. Each study was assessed for the risk of bias, using the Cochrane collaboration's risk of bias tool. RESULTS A total of 640 studies were obtained in the electronic search. After the application of the eligibility criteria, manual search, and duplicate removal, 21 articles were included. Five articles classified their volunteers with internal derangements of the TMJ, in 4 articles the treatment was directed to participants with disc displacement with reduction and the other articles evaluated HA therapy in osteoarthritis. The protocols presented heterogeneity, varying in the form of application, associated or not with arthrocentesis, number of applications, molecular weight, dose and concentration. Nine studies presented high risk of bias. CONCLUSION Due to the heterogeneity and methodological inconsistencies of the studies evaluated, it was not possible to establish the efficacy of HA in articular TMDs.
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Affiliation(s)
- Natália Ferreira
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil.
| | - Danielle Masterson
- Biblioteca do Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Brazil.
| | - Rodrigo Lopes de Lima
- Laboratório de Morfogênese Celular (LMC), Instituto de Ciências Biomédicas (ICB), Universidade Federal do Rio de Janeiro, Brazil; Departamento de Ortodontia e Odontopediatria, Universidade Federal do Rio de Janeiro, Brazil.
| | - Brenda de Souza Moura
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil.
| | - Aleli T Oliveira
- Departamento de Ortodontia e Odontopediatria, Universidade Federal do Rio de Janeiro, Brazil.
| | | | - Antônio C P Carvalho
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil.
| | - Marcos F DosSantos
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil; Laboratório de Morfogênese Celular (LMC), Instituto de Ciências Biomédicas (ICB), Universidade Federal do Rio de Janeiro, Brazil.
| | - Eduardo Grossmann
- Departamento de Ciências Morfológicas, Universidade Federal do Rio Grande do Sul, Brazil.
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Fonseca RMDFB, Januzzi E, Ferreira LA, Grossmann E, Carvalho ACP, de Oliveira PG, Vieira ÉLM, Teixeira AL, Almeida-Leite CM. Effectiveness of Sequential Viscosupplementation in Temporomandibular Joint Internal Derangements and Symptomatology: A Case Series. Pain Res Manag 2018; 2018:5392538. [PMID: 30154944 PMCID: PMC6091395 DOI: 10.1155/2018/5392538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/11/2018] [Accepted: 07/09/2018] [Indexed: 12/26/2022]
Abstract
Viscosupplementation is a minimally invasive technique that replaces synovial fluid by intra-articular injection of hyaluronic acid (HA). Although effective in some joints, there is not conclusive evidence regarding temporomandibular disorders. This case series described the efficacy of a viscosupplementation protocol in intra-articular temporomandibular disorders. Ten patients with a diagnosis of disc displacement and/or osteoarthritis by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to four monthly injections of low or medium molecular weight HA. Pain, mandibular function, image analysis by tomography and magnetic resonance, and quality of life were assessed at baseline and follow-ups (1 and 6 months). Pain, jaw range-of-motion, mandibular function, and quality of life improved at follow-up evaluations. Osteoarthritis changes decreased, and 20% of patients improved mandibular head excursion after treatment. Resolution of effusion and improvement in disc morphology were observed for most patients. This viscosupplementation protocol reduced pain and symptoms associated with internal derangement of temporomandibular joint, improved quality of life, and showed benefits from both low and medium molecular weight HA in alternate cycles.
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Affiliation(s)
| | | | - Luciano Ambrosio Ferreira
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- 9 Hospital Maternidade Therezinha de Jesus-HMTJ/JF, Suprema-Faculdade de Ciências Médicas e da Saúde, Juiz de Fora, Brazil
| | - Eduardo Grossmann
- Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Antonio Carlos Pires Carvalho
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Antônio Lúcio Teixeira
- Departamento de Clínica Médica, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
- Department of Psychiatry and Behavioral Sciences, The University of Texas, Houston, TX, USA
| | - Camila Megale Almeida-Leite
- Programa de Pós-Graduação em Patologia, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
- Departamento de Morfologia, Instituto de Ciências Biológicas, UFMG, Belo Horizonte, MG, Brazil
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Häggman-Henrikson B, Alstergren P, Davidson T, Högestätt ED, Östlund P, Tranaeus S, Vitols S, List T. Pharmacological treatment of oro-facial pain - health technology assessment including a systematic review with network meta-analysis. J Oral Rehabil 2017; 44:800-826. [DOI: 10.1111/joor.12539] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 01/11/2023]
Affiliation(s)
- B. Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Sweden
- Department of Odontology/Clinical Oral Physiology; Umeå University; Umeå Sweden
- Faculty of Odontology; Health Technology Assessment - Odontology (HTA-O); Malmö University; Malmö Sweden
| | - P. Alstergren
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Malmö Sweden
- Department of Rehabilitation Medicine; Skåne University Hospital; Malmö Sweden
| | - T. Davidson
- Faculty of Odontology; Health Technology Assessment - Odontology (HTA-O); Malmö University; Malmö Sweden
- Department of Medical and Health Sciences; Division of Health Care Analysis; Linköping University; Linköping Sweden
| | - E. D. Högestätt
- Department of Laboratory Medicine; Clinical Chemistry and Pharmacology; Lund University; Lund Sweden
| | - P. Östlund
- Department of Odontology/Clinical Oral Physiology; Umeå University; Umeå Sweden
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU); Stockholm Sweden
| | - S. Tranaeus
- Department of Odontology/Clinical Oral Physiology; Umeå University; Umeå Sweden
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU); Stockholm Sweden
| | - S. Vitols
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU); Stockholm Sweden
- Department of Medicine; Division of Clinical Pharmacology; Karolinska Institute; Stockholm Sweden
| | - T. List
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Malmö Sweden
- Department of Rehabilitation Medicine; Skåne University Hospital; Malmö Sweden
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Are intra-articular injections of hyaluronic acid effective for the treatment of temporomandibular disorders? A systematic review. Int J Oral Maxillofac Surg 2016; 45:1531-1537. [DOI: 10.1016/j.ijom.2016.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/14/2016] [Accepted: 06/06/2016] [Indexed: 11/19/2022]
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Is Hyaluronic Acid Injection Effective for the Treatment of Temporomandibular Joint Disc Displacement With Reduction? J Oral Maxillofac Surg 2016; 74:1728-40. [DOI: 10.1016/j.joms.2016.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 11/21/2022]
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Marty P, Louvrier A, Weber E, Dubreuil PA, Chatelain B, Meyer C. [Arthrocentesis of the temporomandibular joint and intra-articular injections : An update]. ACTA ACUST UNITED AC 2016; 117:266-72. [PMID: 27554488 DOI: 10.1016/j.revsto.2016.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Arthocentesis of the temporomandibular joint combined with intra-articular washout and, more recently, intra-articular injection of pharmacological agents has been developed from the 1990s and is nowadays extensively in use for the treatment of temporomandibular dysfunctions (TMDs). The goal of our work was to answer 3 questions: 1. Is intra-articular washout effective for the treatment of TMDs ? 2. What kind of pharmacological agents may nowadays be injected in addition to washout and are these injections useful ? 3. What is the place of these treatments in the treatment strategies of TMDs ? MATERIAL AND METHODS A bibliographic research has been carried out in the PubMed database using following keywords arthrocentesis, temporomandibular joint. The 27 articles published between 1991 and 2016, indicating patient's inclusion criterions and objectively evaluating the clinical results (mouth opening, intra-articular noises, pain) were selected. Pharmacological agents were noticed when used. RESULTS 1. All authors concluded to the efficacy of intra-articular washout. No prognostic factor for arthrocentesis efficacy could be identified. 2. Main pharmacological agents used were steroids, hyaluronic acid, morphine-based drugs and platelet rich plasma. Superiority of ith-injection protocols failed to win unanimous support. All authors who compared with- and without-injection protocols concluded to the superiority of with-injection protocols, whatever the agent. DISCUSSION Numerous studies have proven the efficacy of intra-articular washout for the treatment of TMDs resistant to noninvasive treatments. The advantage of any kind of pharmacological agent is not clear. Mechanisms of action are not all elucidated. No pharmacological agent showed any superiority over another. Study methodologies are often defective: imprecise inclusion criterions, short follow-up, confounding variables not taken into account, few comparison between pharmacological agents.
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Affiliation(s)
- P Marty
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France.
| | - A Louvrier
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - E Weber
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - P-A Dubreuil
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - B Chatelain
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - C Meyer
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; Nanomedicine Lab, Imagery and Therapeutics-UFR SMP, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
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Bouloux GF, Chou J, Krishnan D, Aghaloo T, Kahenasa N, Smith JA, Giannakopoulos H. Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short Term for Improving Function and Quality of Life After Arthrocentesis? Part 2. J Oral Maxillofac Surg 2016; 75:63-72. [PMID: 27632067 DOI: 10.1016/j.joms.2016.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 08/11/2016] [Accepted: 08/11/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Although arthrocentesis has been used for the management of patients with temporomandibular joint pain, the benefit of hyaluronic acid (HA) or corticosteroid (CS) remains uncertain. The purpose of this study was to assess the efficacy of HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis for changes in quality of life (QoL), jaw function (Jaw Function Limitation Scale [JFLS] score), and maximum incisal opening (MIO). MATERIALS AND METHODS This was a prospective multicenter double-blinded randomized clinical trial. Consecutive patients presenting to the oral and maxillofacial departments at Emory University, the University of Pennsylvania, the University of California-Los Angeles, the University of Cincinnati, and the Oregon Health Sciences University were enrolled in the study. Patients were randomized to HA, CS, or LR. All patients underwent arthrocentesis and then instillation of HA, CS, or LR. All patients were evaluated clinically at 1 and 3 months. The outcome variables were QoL, JFLS score, and MIO. Univariate, bivariate, and multivariate statistics were computed, with a P value less than .05 considered significant. RESULTS One hundred two patients were enrolled in the study. Four were lost to follow-up, leaving 98 patients for analysis of data at 1 month. An additional 51 were lost to follow-up at 3 months, leaving 51 patients for data analysis at this time point. There was no difference among groups for QoL Mental Health Composite score at 1 month (P = .70) or 3 months (P = .69). There was no difference among groups for JFLS score at 1 month (P = .71) or 3 months (P = .98). There was no difference among groups for MIO at 1 month (P = .47) or 3 months (P = .31). All groups showed within-group improvements in JFLS score and MIO at 1 and 3 months. CONCLUSION Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in improving jaw function and MIO at 1 and 3 months. QoL is not improved with arthrocentesis alone or in combination with CS or HA.
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Affiliation(s)
- Gary F Bouloux
- Associate Professor, Department of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Jolie Chou
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University Buffalo New York, Buffalo, NY; formerly, University of Pennsylvania, Philadelphia, PA
| | - Deepak Krishnan
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH
| | - Tara Aghaloo
- Professor, Department of Oral and Maxillofacial Surgery, University of California-Los Angeles, Los Angeles, CA
| | - Nora Kahenasa
- Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, University of California-Los Angeles. Los Angeles, CA
| | - Julie Ann Smith
- Associate Professor, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR
| | - Helen Giannakopoulos
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA
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Bouloux GF, Chou J, Krishnan D, Aghaloo T, Kahenasa N, Smith JA, Giannakopoulos H. Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short-Term Reduction of Temporomandibular Joint Pain After Arthrocentesis? Part 1. J Oral Maxillofac Surg 2016; 75:52-62. [PMID: 27632069 DOI: 10.1016/j.joms.2016.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/27/2016] [Accepted: 08/06/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE Arthrocentesis has been used for the management of patients with temporomandibular joint (TMJ) pain, with good success. The additional use of hyaluronic acid (HA) or corticosteroid (CS) remains controversial. The purpose of this study was to compare HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis. MATERIALS AND METHODS This was a prospective multicenter double-blinded randomized clinical trial. Consecutive patients presenting to the oral and maxillofacial departments at Emory University, the University of Pennsylvania, the University of California-Los Angeles, the University of Cincinnati, and the Oregon Health Sciences University were enrolled in the study. Patients were randomized to HA, CS, or LR. All patients underwent arthrocentesis and then the instillation of HA, CS, or LR. Patients were evaluated clinically at 1 and 3 months. The primary outcome variable was pain at 1 month (by visual analog scale). Secondary outcome variables were pain at 3 months and analgesic consumption. Univariate, bivariate, and multivariate statistics were computed, with a P value less than .05 considered significant. RESULTS One hundred two patients were enrolled in the study. Four were lost to follow-up, leaving 98 patients for the final analysis. The mean age of patients in the HA, CS, and LR groups was 39.6, 44.3, and 51.8 years, respectively (P = .02). There was no difference among groups in time to follow-up at 1 month (P = .11). The mean decrease in pain in the CS group was 19% for right-side procedures (P = .12) and 36% for left-side procedures (P = .02). The mean decrease in pain in the HA group was 31% for right-side procedures (P = .01) and 34% for left-side procedures (P = .01). The mean decrease in pain in the LR group was 43% for right-side procedures (P < .01) and 37% for left-side procedures (P < .01). There was no difference in pain decrease among groups (P = .55). There was no difference in the use of narcotic (P = .52) or nonsteroidal anti-inflammatory drugs (P = .71) among groups. CONCLUSION Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in decreasing TMJ pain.
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Affiliation(s)
- Gary F Bouloux
- Associate Professor, Department of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Jolie Chou
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University Buffalo New York, Buffalo, NY; formerly, University of Pennsylvania, Philadelphia, PA
| | - Deepak Krishnan
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH
| | - Tara Aghaloo
- Professor, Department of Oral and Maxillofacial Surgery, University of California-Los Angeles, Los Angeles, CA
| | - Nora Kahenasa
- Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, University of California-Los Angeles, Los Angeles, CA
| | - Julie Ann Smith
- Associate Professor, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR
| | - Helen Giannakopoulos
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA
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